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Publications

Journal Article Ahead of print

PubMed: 42234234 DOI: 10.1007/s00701-026-06943-y

Dexmedetomidine versus propofol for sedation in awake neurosurgery: respiratory and hemodynamic safety.

Acta Neurochir (Wien)

Authors: Charlotte Levé, Fabrice Vallée, Sylvie Aubrun, Séverine Levavasseur, Mickael Rajaona, Kanssaa El Ayeb, Emmanuel Mandonnet, Cyril Touchard, Joaquim Mateo, Jérôme Cartailler, Jona Joachim

Affiliations

  • Université Paris Cité, Inserm UMRS 942 Mascot, F-75006, Paris, France. Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, F-75010, Paris, France.
  • Université Paris Cité, Inserm UMRS 942 Mascot, F-75006, Paris, France.
  • Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, F-75010, Paris, France.
  • Department of Neurosurgery, AP-HP, Hôpital Lariboisière, F-75010, Paris, France.
  • Université Paris Cité, Inserm UMRS 942 Mascot, F-75006, Paris, France. Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, F-75010, Paris, France.

Abstract

PURPOSE

Monitored anesthesia care (MAC) with continuous sedation for awake craniotomy allows rapid recovery but increases risks of hypoventilation and hypoxemia. In April 2019, our center replaced propofol-based sedation with dexmedetomidine-based protocols to improve respiratory safety. We evaluated the impact of this protocol change on respiratory and hemodynamic outcomes.

METHODS

This single-center retrospective before-after observational study analyzed all adult patients undergoing awake craniotomy between April 2017 and July 2021. The propofol group (April 2017-March 2019) received propofol-remifentanil sedation; the dexmedetomidine group (April 2019-July 2021) received dexmedetomidine-based sedation with supplemental low-dose propofol. Primary endpoints were hypoxemia (SpO2 < 92%) and hypercarbia (PaCO2 and transcutaneous PCO2). Secondary endpoints included hemodynamic stability and adverse events.

RESULTS

We included 103 patients (51 propofol, 52 dexmedetomidine). Desaturation below 92% occurred more frequently in the propofol group (40% vs. 17%, p = 0.04). PaCO2 levels were significantly lower with dexmedetomidine across all sedation periods (period 1: 52 ± 0.9 vs. 64 ± 2 mmHg, p < 0.0001; period 2: 52 ± 1 vs. 66 ± 2 mmHg, p = 0.0002; period 4: 48 ± 0.8 vs. 51 ± 1 mmHg, p = 0.03). Mean arterial pressure was higher and less variable in the dexmedetomidine group (p < 0.01). Blood loss exceeding 500 mL was more common with propofol (41% vs. 19%, p = 0.027). Mapping conditions were excellent in both groups (96%).

CONCLUSIONS

In this single-center retrospective study, transitioning from propofol-based to dexmedetomidine-based sedation for awake craniotomy was associated with improved respiratory and hemodynamic safety.

MeSH

Craniotomy, Safety, Propofol, Neurosurgery, Hemodynamics, Dexmedetomidine